I read your last newsletter regarding your surprise and disappointment with your recent experience on the fringes of Obamacare and I thought I would drop you a line. All I can tell you is, “you ain’t seen nothing yet”. For the past few years I have been working at the forefront of this movement, both in an IT and a physician capacity.

My hospital system is one of the 32 pioneer ACO‘s in the country, which are basically the test beds for the model of care that Obamacare embodies. Between that and the governmental EMR incentive program (meaningful use) I have been very involved in implementing the computer systems and complying with the new regulations. I have also been involved in delivering patient care under this new model. So at this point I probably have as much experience and insight about this as anyone.

I think many people will be very surprised at the changes they will experience under this new system. Objectively some people will do much better under this system but many people will do much worse. Obamacare will be a godsend for people who did not have insurance and couldn’t qualify for medicaid, and also for people with pre-existing conditions. Those people will finally be able to get coverage, though it will be more expensive than they thought. It will have to be government subsidized for many.

For people who already have insurance, this system will turn out to be nightmare. It is filled with counter productive and bureaucratic rules and regulations that force physicians to worry more about compliance than patient care. The hassle factor for patient and physician alike is going through the roof. Physician and hospital compensation is being tied to complying with the rules, which may be well meaning but will have a ton of unintended consequences.

The new paradigm for a 15 minute doctors visit is becoming 5 minutes with the patient and 10 minutes with the computer. It is all about “population health”, which if you didn’t know is beaurospeak for rationing. The individual is just not very important in this type of system. Combine this with 35 million new patients and a shortage of primary care docs and you don’t need to be a genius to see that something has got to give.

I actually admire Obama for at least trying to do something. Most of our politicians are scared to try anything new and are essentially worthless. And I do think that no one should go without healthcare in this country. But unfortunately the majority of us are going to pay a very heavy price so the rest of us can have healthcare. The consequences of Obamacare will be far reaching and extremely unpleasant for many care givers and patients alike.

The outcome of this is going to be a multi-tiered system, similar to what goes on now but even more stratified. The rich will be able to pay for the type of care they want and they will find many physicians that are more than happy to provide that. This is the type of care that most people would want and the way most doctors would want to practice.

The poor will at least have some healthcare and anything is better than nothing. They will get the type of population based healthcare incentivized by our government. The rest of us will do the best we can and put up with increased costs, decreased quality, increased hassles, longer wait times, and difficulty accessing the system. We will learn what it means to be a “covered life” rather than an individual patient. Under this new paradigm our healthcare system will become a few islands of excellence in an ocean of mediocrity.

This depresses me even further. What if he leaves the profession? How can we fix this before it’s too late?